American Indians and Alaska Natives (AI/ANs) are especially susceptible to respiratory diseases. According to Indian Health Service statistics, influenza/pneumonia is the 6th leading cause of death among all AIs and the 4th among Native elders. Moreover, mortality increases markedly with age; for persons greater than or equal to 65 years, mortality due to AI/ANs are not available, minority populations receive influenza (IV) and pneumococcal (PV) vaccinations at substantially lower rates than whites. Since minority adults utilize preventive services loss, present for care at more advanced stages of disease, and have greater morbidity and mortality than higher income individuals, AI/AN elders are at risk for not obtaining IV and PV. In this regard, our pilot work with urban Native elders in a primary care practice found that only 31% and 21%, respectively, in accordance with published guidelines. Thus, the Specific Aims of this project are to: 1) compare the effectiveness of "usual care" to 2 patient-targeted interventions in promoting immunizations among AI/AN elders at a large urban health center (either receipt of culturally appropriate educational materials addressing knowledge, attitudes, and beliefs informed by focus groups or an incentive); 2) assess the effectiveness of provider-targeted peer feedback versus usual care in increasing vaccination rates; and 3) examine patient-related factors influencing receipt of immunizations. To accomplish this we will conduct a randomized, controlled, clinical trial to assess improvement in IV and PV rates among an elderly AI/AN clinic population. During Year 1, focus groups will help develop culturally appropriate educational materials determine the incentive, as well as facilitate an understanding of reasons for non-adherence to guidelines. In Year 2, eligible Native elders will receive culturally appropriate educational materials, an incentive, or usual care. In Year 3, a physician- targeted feedback intervention will consist comparisons to rates of peer administration of IV and PV. During Years 4 and 5, we will complete the data collection and analysis, than meet with health leaders from 5 Northwest tribes to evaluate the feasibility of putting into practice the successful portions of the planned intervention in local reservation-based communities. These objectives are consistent with the Healthy People 2000 National Health Promotion and Disease Prevention Objectives to achieve IV and PV coverage rates of greater than or equal to 60% among community-dwellers aged greater than or equal to 65 living and high-risk populations.